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pharm: coagulation
Drugs affecting coagulation
| Drug | Indication | Mechanism of action | Adverse effects | Contraindications | Baseline tests | Patient Education | Antidote |
|---|---|---|---|---|---|---|---|
| Heparin | Anticoagulant. Prevents the extension of blood clots in patients with PE or DVT. Has no effect on existing clots. | Rapidly promotes the inactivation of factor X, which prevents the conversion of prothrombin to thrombin and fibrinogen to fibrin. This limits clot formation. Prolongs bleeding time. | Bleeding and heparin induced thrombocytopenia (HIT) | Hypersensitivity (beef or pork), bleeding disorders, active bleeding, thrombocytopenia, use during or after surgery. | aPTT and platelet count and PLT | Monitor for signs of bleeding. Use soft toothbrush or electric razor to mimimize bleeding. Safe for pregnant women. | protomine sulfate |
| Ateplase, recombinant (Activase) | Breaking down already formed blood clots which pose acute medical emergencies (MI, PE, ischemic stroke) | tPA synthesized by recombinant DNA technology. Binds to fibrin in the clot then converts plasminogen to plamin. Fibrinolysis occurs. | Internal or superficial bleeding. | Hypersensitivity,active internal bleeding, hemorrhagic stroke, severe HTN and recent surgeries. Increased risk of bleeding with anticoagulants. | platelet count aPTT, PT, Hgb and Hct | ||
| Lovastatin (Mevacor) | Primary hyperlipidemia. Secondary prevention of coronary events (MI and stroke) | Completely inhibits HMG-CoA reductase, which is the enzyme that catalyzes the early rate limiting step in cholesterol biosynthesis Increased HDL, decreased LDL, decreased cholesterol, decreased VLDL and decreased triglycerides. | Muscle and joint aches, weakness, cramps, rhabdomyolysis, myopathy and elevated liver enzyme levels. | Active liver disease and pregnacy (category X). Grapefruit juice decreases CYP3A4 and increases drug levels. (risk for myopathy). | cholesterol, LDL, HDL, triglycerides, LFT's, CPK's and grapefruit juice intake/output. | photosensitivity.Following a low- cholesterol and low-saturated fat diet. | |
| Gemfibrozil (Lopid) | Management of hyperlipidemia | decreased triglyceride production by the liver, decreased VLDL, increased HDL. | gallbladder stones, myopathy, abnormal liver enzyme levels. | gallbladder disease, liver and renal disease | HDL, LDL, triglyceride levels, renal and liver function tests. | Take 30 min before breakfast and dinner. | |
| Ezetimide (Zetia) | Management of hyperlipidemia. Decreased absorption of cholesterol from food, decreased LDL. | decreased absorption of cholesterol from food, decreased LDL | diarrhea and myalgia | liver and renal disease | HDL, LDL, triglyceride levels, renal and liver function tests. | Take without regard to food | |
| Cholestyramine (Questran) | Management of hyperlipidemia | binds bile acids in the GI, increased clearance of cholesterol, decreased LDL | constipation, vitamin K deficiency, increased triglycerides | biliary disease, elevated triglycerides and VLDL | HDL, LDL, triglyceride levels. | Take before meals | |
| LMWH (Lovenox) and (Arixtra) | derived from standard heparin. Less bleeding and less HIT | Black box warning regarding the use of epidural/spinal anesthesia or spinal puncture. Increased risk of epidural or spinal hematoma. | Teach patients how to self inject | ||||
| Warfarin (Coumadin) | Anticoagulant. Used after heparin therapy. Used in patients with a high risk for thrombus formation. | Completely blocks vitamin K at its action sites. Prevents activation of factor X and prothrombin. | Bleeding, hemmorhage, NVD | Active bleeding, PUD or bleeding disorders (hemophilia), thrombocytopenia, use during or after surgery. | PT and INR | Vitamin K (green leafy vegetables) decrease the effects. Pregnancy category X. Discontinue 7 days before surgery. Give in the evening after 6pm to allow morning blood draws. | Vitamin K (phytonadione) |
| Clopidogrel (Plavix) | Used to reduce the occurrence of atherosclerotic events in patients who have had MI or stroke or who are at high risk (PAD). PRODRUG: requiring activation by CVP2C19 | Inhibits binding of adenosine diphosphate (ADP) to its platelet receptor and the subsequent ADP- mediated activation of the glycoprotein IIb/IIIa complex and inhibits platelet aggregation. Prolongs bleeding time. | Bleeding, GI distress, neutropenia | Hypersensitivity and active bleeding disorders (PUD). Anticoagulants increase risk of bleeding. | CBC, platelet function, LFT, CV exam | Lab tests are needed on a regular basis. Discontinue 7 days before surgery. Take with food to decrease GI problems. Heart healthy diet. | |
| Aspirin | Low dose is used for prophylaxis against MI and stroke. Provides reduction in the risk for MI and stroke.TXA2 is a vasoconstrictor that promotes platelet aggregation. | Inhibits platelet aggregation by inhibiting COX and the synthesis of throboxane and A2. | bleeding (GI bleeding and ulceration) and neutropenia. | Take with food to avoid GI distress. |
Created by:
lehasler
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